Dr.

Muntaha Virk
 Introduction
 What is EBM/EBP
 Importance of EBM/EBP
 A new approach for quality care
 Implementation steps toword EBP
 Hindrances to EBP
 Convincing of the employer
 What PTs should know to become an evidence based
clinicians.
 Research question formulation
 E-model for EBP .
 A leader/consultant/Independent Practioner
 A respectable health care team member
 Able to lead the rehabilitation team.
 Able to evaluate, diagnose and treat patient
with direct access.
 A vast field not a subject, with further
specialties.
 A whole body approach for treatment
 Integration of the best research evidence with
clinician’s expertise and patient values (Straus,
2005).
 It is an approach to decision-making in which the
clinician uses the best available evidence in
consultation with the patient, to find the best
treatment option for the patient. Muir Gray JA.
(1997).
 "Evidence based medicine is the conscientious,
explicit, and judicious use of current best evidence
in making decisions about the care of individual
patients. (Sackett, D.L. et al. (1996).
 Research based Knowledge only.
 Evidence-based medicine is a "cook-book"
medicine.
 Cost-cutting medicine promoted by
purchasers and managers .
 No value for clinical expertise.
 Quality care for the patients.
 Knowledge and skills can make a professional
confident.
 Control over utilization.
 Discontinue with worthless medical
procedures and therapeutic techniques.
 The most current & effective interventions to
enhance the quality of life .
 Quality Care
 Confidence
 knowledge
 Control over utilization
 Discontinue with worthless medical
procedures and therapeutic techniques.
 Cost effective care
 Minimize medical mistakes to happen
 Unified treatment for the same diagnosis.
 Measurable outcome
 Integration of the best external evidence
with individual clinical expertise and
patient-choice.
 Promotes the collection, interpretation, and
integration of valid, important and
applicable patient-reported, clinician-
observed, and research-derived evidence.
 The focus is on the quality care and
measurable outcome of the procedures and
therapeutic techniques.
1. Convert the patient problem in to a
specific question.
2. Literature search for evidence related to
the question or problem.
3. Critically appraise the literature.
4. Integrate the research evidence with the
clinician’s expertise and the patient
circumstances and values.
5. Incorporate the information and
discussion into clinical practice.
6. Re-evaluate the outcome and ask an other
question if needed.
 Access to different databases.
 Could be more expensive and time
consuming.
 Case load & time management may be
problem.
 Special training to acquire knowledge and
skills.
 Employers/directors cooperation.
 Focus on the quality care and measurable
outcome.
 Increase reputation that may attract more
patients.
 Decrease the chance of medical mistakes to
happen.
 Control over utilization and discontinue
with worthless medical procedures and
therapeutic techniques.
 Minimum investment may bring more profit
to the organization.
The PTs should know the key concepts in
rehabilitation;

 Awareness
 Consultation
 Judgment
 Creativity
 Internet access.
 Access to different databases.
 Faculty Training to acquire knowledge and
skills about EBP.
 Save the search work.
 Create a list of authentic databases.
 Create a format, which guides the therapist,
how to search and what to search for?
 Boolean: The words AND,OR,NOT and NEAR; used
to combine search terms in search engines.
 Search engines;e.g. Google, yahoo etc.
 Diagnosis: A process that integrates and evaluates
data.
 Examination: A comprehensive screening.
 Mesh: Medical subject heading The term used to
describe approved search vocabulary in the US.
 Outcome: The end result of patient/client
management.
 Prognosis: prediction
 Search String: A Combination of key
words,phrases,names etc. used to search evidence.
 Key word(s): The word(s) or terms use to search for
evidence.
Question may pertain to:
1. The anatomic, physiologic or patho physiologic
nature of the problem.
2. The Medical and surgical management options
3. The usefulness of the diagnostic tests and
measure to identify, classify, and or quantify the
problem.
4. Prognosis factors.
5. Advantage and disadvantage of the intervention.
6. The nature of outcome and how to measure
them.
 Background" questions ask for general knowledge about a
condition or thing.
 Background Questions reflect a desire to know the nature of
the patient problem or need.
 Often focus on the medical aspects of the situation rather
than on the physical therapy component.
 Physical therapy students and new graduates will use to learn
about new techniques or skills
 Experienced professionals will use background questions for
new or unusual situation.
Examples:
“What are the signs and symptoms of an exacerbation of
multiple sclerosis?”
 Foreground" questions ask for specific knowledge
to inform clinical decisions or actions.
 Ask for specific knowledge about managing
patients with a disease.
Example: In young children with acute otitis media, is
short-term antibiotic therapy as effective as long
term antibiotic therapy?
 Diagnosis : How to select a diagnostic test or how to interpret
the results of a particular test .
 Therapy :Which treatment is the most effective, or what is an
effective treatment given a particular condition.
 Harm or etiology :Are there harmful effects of a particular
treatment, or how can these harmful effects be avoided.
 Prognosis :What is the patient's likely course of disease, or
how to screen for or reduce risk.
 Prevention: How can the patient's risk factors be adjusted to
help reduce the risk of disease?
 Qualitative :Helps to understand clinical phenomena with
emphasis on understanding the experiences and values of
patients.
 We should know the necessary factors for
decisions-making
 Theoretical ground, previous experience,
client/patient wishes,environmental
conditions, and research evidence.
 Reflection is a metacognative process We are
thinking about our thinking).
 As Physical Therapists we should know the
reasons underlying Our actions.
 We should use reflection in our action.
 In routine practice experienced Therapists do
not pay any attention.
 Only when they face a new challenge.
 Reflection represents the “art” of practice and
knowledge and evidence the “science” of
practice.(Schon 1987)
 Novice Practitioners need rules to help them
organize their thoughts, observations, and
action.(Bnner,1984)
 They focus on objective findings.
 The complexities of the patients relationship,
the environment and the expectations are
beyond the capacity of the novice
practitioners.
 Expert practitioners maintain these rules but
shift them to the background.
 They have the capability to handle new
situations by using their professional
experience.
 They understand the individual patient
situation and can create the environment too,
based on knowledge and experience.
The five main components of the E-Model:
 Expectations
 Environment
 Experience
 Ethics
 Evidence
 Expectations of the patient/client
 We should move to words Patient-Centered
model.
 The patient should define goals and
communicate his/her problem clearly.
 The patient should define the outcomes.
 The patient brings the expertise about
his/her life situation, values and beliefs.
 The therapist brings the expertise how to
work to gather to achieve the patient's
goals.
 Suitable environment is very important.
 The environment exerts powerful influence
on our beliefs, thoughts, and action.
 Cultural and social norms and values
influence recommendations.
 The physical location of service delivery
also influence the decision making process.
 Physical,cultural,social,political,and
institutional aspects of the environment are
necessary when making decisions and
recommendations.
 The experience is a powerful force
influencing decision making.
 Experience may include our knolwedge,both
our professional preparation at
undergraduate and graduate level and with
continuous education.
 These formal experiences set the stage for
new development of new ideas, reflection
on current knowledge, and incorporation of
the new knowledge into one’s collection of
skills.
 The ethics role in the health care is very
important.
 In rehabilitation we usually face issues of
access,confedenciality,determination of
services and conflicts of interest.
 The therapist is the advocate of the patient
and should not take any action or give any
recommendation which is
inappropriate/harmful for the patient/client.
 Clinical decision making had been strongly
influenced by the practitioner’s education and
by the opinions of the experts in the field.
 EBP is the key part of rehabilitation practice
today.
 Availability of the evidence both in quantity
and quality.
 Access to the evidence is not difficult.